Healthcare Provider Details

I. General information

NPI: 1649267394
Provider Name (Legal Business Name): TLCS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HAMILTON ST
DES ARC AR
72040-3123
US

IV. Provider business mailing address

102 HAMILTON ST
DES ARC AR
72040-3123
US

V. Phone/Fax

Practice location:
  • Phone: 870-256-1220
  • Fax: 870-256-1223
Mailing address:
  • Phone: 870-256-1220
  • Fax: 870-256-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY MICHAEL PRUITT
Title or Position: PRESIDENT/PARTNER
Credential: APN
Phone: 870-256-1220